坏疽性脓皮病合并炎症性肠病

报告1例坏疽性脓皮病合并炎症性肠病。患者男,30岁。腹痛、腹泻及稀薄脓血便1个月余;躯干及四肢出现散在的红色丘疹、脓疱疹,溃疡伴疼痛12 d入院。皮损组织病理检查:表皮角化过度,棘层增厚,真皮全层及皮下脂肪间大量中性粒细胞浸润,可见红细胞外渗及血管壁纤维蛋白样变性。电子肠镜诊断为炎症性肠病。抗核周型中性粒细胞胞质抗体(anti perinuclear antineutrophil cytoplasmic antibody,p-ANCA)阳性。予糖皮质激素、美沙拉嗪及支持治疗后,患者病情明显好转。     

Steroid allergy in patients with inflammatory bowel disease

Background: Contact allergy to a steroid enema leading to worsening of inflammatory bowel disease (IBD) has recently been reported. This study was designed to look for evidence of steroid allergy in patients with IBD. OBJECTIVES: To look for the presence of steroid allergy in general, and steroid enema allergy in particular, in a cohort of IBD patients prepared to attend for patch testing. METHODS: Patients with IBD in two gastroenterology units at Dublin and Cork were asked to take part in the study. Those who agreed to take part were tested to the British Contact Dermatitis Society standard and steroid batteries. Patients with positive tests to steroids were subsequently asked to attend for intradermal testing with prednisolone, and patch testing to the two commercially available steroid enemas in Ireland and an extended battery of steroids. Reactions were read at days 2 and 4. RESULTS: In total, 44 patients from the two units were patch tested. Four patients had positive patch tests to one or more steroids in these batteries: budesonide (n = 2), triamcinolone acetonide (n = 1), tixocortol pivalate (n = 1) and prednisolone (n = 1). Of these, three underwent further testing. All three had positive reactions to intradermal prednisolone and one had a positive test to steroid enema. CONCLUSIONS: Four (9%) of our patients were found to have steroid allergy. This has important implications for the local and systemic treatment of their IBD.     

Prevalence of inflammatory bowel disease in Japanese psoriatic patients

Psoriatic patients reportedly have a higher prevalence of inflammatory bowel disease (IBD); however, there have been few research studies of Japanese psoriatic patients. To elucidate the prevalence of IBD in Japanese psoriatic patients, a cross‐sectional study was performed. Information was collected regarding psoriatic patients with current or prior history of Crohn's disease (CD) or ulcerative colitis (UC) who were treated at Fukuoka University Hospital from 2010 to 2018. Among 681 psoriatic patients (449 men and 232 women), eight (1.2%, six men, two women) had UC and two (0.3%, one man, one woman) had CD. Diagnosis of IBD preceded psoriasis in five patients, while diagnosis of psoriasis preceded IBD in two; the remaining patients’ records did not have sufficient information. Seven of 10 UC‐positive patients had mild psoriasis, two had moderate psoriasis and one had severe psoriasis. When UC‐positive psoriatic patients were compared with IBD‐negative psoriatic patients, there were no differences in age at onset of psoriasis, age at first visit or complications (e.g. psoriatic arthritis, hypertension, hyperlipidemia, hyperuricemia and diabetes). However, UC‐positive patients had significantly higher body mass index (BMI) (26.7 vs 23.7; P = 0.021), compared with patients without IBD. The CD/UC ratio in this cohort was 0.25, while the prevalence of IBD was 1.2%; these values were both lower than those in previous reports involving Caucasian patients. Patients with psoriasis and UC may have higher BMI and milder skin symptoms than those with psoriasis alone. These observations must be further confirmed by controlled domestic studies with larger samples.     

Cutaneous manifestations of metastatic Crohn's disease

Metastatic Crohn's disease is a rare cutaneous complication of primary Crohn's disease. It is a granulomatous inflammatory process, similar to the pathogenic mechanism of Crohn's disease, that occurs in sites discontiguous from the gastrointestinal tract. Metastatic Crohn's disease can precede the development of Crohn's disease by months to years, and children are more likely to present with metastatic Crohn's disease in the absence of gastrointestinal symptoms. Given that approximately 30% of individuals with Crohn's disease present in childhood, early recognition of extraintestinal manifestations of Crohn's disease such as metastatic Crohn's disease can aid in timely diagnosis and management of bowel disease. We present data from two pediatric cases of metastatic Crohn's disease recently seen at our institution in addition to the 61 reported cases of pediatric metastatic Crohn's disease in the literature. This review article will focus on the epidemiology, pathogenesis, clinical features, and histology of and treatment options for pediatric metastatic Crohn's disease.     

儿童炎症性肠病50例皮肤表现分析

【摘要】 目的 分析儿童炎症性肠病（IBD）的皮肤表现。方法 回顾性分析2010年1月至2022年1月北京大学第三医院儿科病房收治的IBD患儿的皮肤表现。结果 纳入IBD患儿50例,其中27例克罗恩病,23例溃疡性结肠炎（UC）。25例（50%）患儿有皮肤表现,特异性皮肤表现和相关性皮肤表现各11例（各占22%）。特异性皮肤表现包括2例肛周皮肤克罗恩病、9例肛瘘和/或肛周脓肿;相关性皮肤表现包括5例结节性红斑、3例阿弗他口炎、1例银屑病、1例结节性多动脉炎、1例过敏性紫癜。与UC组相比,克罗恩病组更易出现特异性皮肤表现和相关性皮肤表现,两组差异有统计学意义（均P＜0.05）。27例克罗恩病患儿中,19例（70%）有1种或以上皮肤表现,其中2例先后出现4种不同皮肤表现。1例克罗恩病和1例UC患儿不同时期出现过3种不同皮肤表现。有皮肤表现的患儿粪便钙卫蛋白均升高,无皮肤表现患儿中12例（48%）粪便钙卫蛋白升高。5例患儿在生物制剂调整剂量（1例）或转换（4例）后皮损好转或消退。结论 半数IBD患儿有皮肤表现,克罗恩病患儿更易出现特异性和相关性皮肤表现。同一患儿不同时期可伴有不同皮肤表现。多学科团队协作有利于该病的整体控制。     

银屑病与炎症性肠病的共同发病通路及靶向药物

 目前银屑病与炎症性肠病被认为是慢性系统性炎症性疾病,并且越来越多的证据表明两者互为共患病。它们在病理生理机制上有许多重叠,因而靶向这些共同发病通路的药物成为当前治疗这两种共患病的热点。本文综述银屑病与炎症性肠病中共同发病通路,包括细胞外的肿瘤坏死因子、IL-23、IL-17信号通路,以及细胞内的JAK-STAT通路、cAMP信号通路、ROR-γT/Th17轴,简要总结靶向这些共同发病通路的新兴药物,以期为临床治疗两种共患病提供一定思路。     

Pediatric facial pyoderma gangrenosum preceding the diagnosis of inflammatory bowel disease

We describe two adolescent patients with pyoderma gangrenosum (PG) involving the face. Subsequent gastrointestinal evaluation revealed microscopic bowel inflammation suggestive of inflammatory bowel disease. While PG is rarely localized to the face, this brief report reveals two cases of pediatric facial PG and suggests a correlation between facial PG and microscopic colitis.     

Oral manifestations of COVID‐19 disease: A review article

Dysgeusia is the first recognized oral symptom of novel coronavirus disease (COVID‐19). In this review article, we described oral lesions of COVID‐19 patients. We searched PubMed library and Google Scholar for published literature since December 2019 until September 2020. Finally, we selected 35 articles including case reports, case series and letters to editor. Oral manifestations included ulcer, erosion, bulla, vesicle, pustule, fissured or depapillated tongue, macule, papule, plaque, pigmentation, halitosis, whitish areas, hemorrhagic crust, necrosis, petechiae, swelling, erythema, and spontaneous bleeding. The most common sites of involvement in descending order were tongue (38%), labial mucosa (26%), and palate (22%). Suggested diagnoses of the lesions were aphthous stomatitis, herpetiform lesions, candidiasis, vasculitis, Kawasaki‐like, EM‐like, mucositis, drug eruption, necrotizing periodontal disease, angina bullosa‐like, angular cheilitis, atypical Sweet syndrome, and Melkerson‐Rosenthal syndrome. Oral lesions were symptomatic in 68% of the cases. Oral lesions were nearly equal in both genders (49% female and 51% male). Patients with older age and higher severity of COVID‐19 disease had more widespread and sever oral lesions. Lack of oral hygiene, opportunistic infections, stress, immunosuppression, vasculitis, and hyper‐inflammatory response secondary to COVID‐19 are the most important predisposing factors for onset of oral lesions in COVID‐19 patients.     

银屑病与慢性炎症性肠病的相关性研究进展

银屑病和慢性炎症性肠病这两种炎症性疾病在发病机制方面具有一定的共性,皮肤和肠道同时代表身体内外两侧的屏障和连接.二者均有多基因遗传背景且在炎症反应过程中存在重叠,在流行病学和治疗上的联系也进一步证实了二者发病机制的相关性.全基因组关联研究的发展已证实银屑病和慢性炎症性肠病的遗传相关性.Th17、调节性T细胞和细胞因子如白细胞介素12、23、17、肿瘤坏死因子α和干扰素γ也被证实在银屑病和炎症性肠病的发病过程中起作用.流行病学研究发现,二者常合并发生并且此类患者银屑病初发时间更早、病情更重、病程更长,同时合并症更多,二者合并是否影响疾病治疗及预后尚缺乏大样本流行病学研究.目前银屑病合并慢性炎症性肠病的治疗仍有局限,多种新型生物制剂将为炎症性肠病合并银屑病的治疗提供新的选择.     

Review of stem cells as promising therapy for perianal disease in inflammatory bowel disease

Those patients with perianal Crohn’s disease or ulcerative colitis experience a difficult to treat disease process with a delayed state and often inability to heal despite current therapies. The approaches currently used to treat these patients with corticosteroids, antibiotics, immunomodulators, anti-tumor necrosis factor-α drug, and surgical repair are limited in their healing ability. This review presents all current literature since emergence in the early 2000s of stem cell therapy for patients with perianal inflammatory bowel disease and analyzes the efficacy, outcomes and safety within these studies.     

A case of linear IgA disease occurring in a patient with colonic Crohn's disease

Linear IgA disease has been reported in association with inflammatory bowel disease, in particular ulcerative colitis. We experienced a case of linear IgA disease that occurred simultaneously with colonic Crohn's disease in a 55-year-old woman and rather unusually both skin and bowel disease improved in tandem. We report the presentation, investigations and subsequent improvement of our patient and speculate on possible causes.     

Immunosuppressive regimens and outcomes of inflammatory bowel disease patients requiring kidney transplantation

Patients with inflammatory bowel disease (IBD) can develop extra-renal complications and as a result, suffer from end stage renal failure requiring kidney transplantation (KT). A brief review of available literature revealed that IBD patients undergoing KT have shorter overall survival rates compared to their controls. Literature reporting steroid regimens and survival outcomes specific to IBD and post kidney transplant are scarce and these studies have small sample sizes thus making it difficult to draw accurate conclusions. Further research is required in the form of a randomized controlled study to clarify the effect and mechanism of steroid immunosuppression on the prognosis of renal transplant recipients and explore new treatment schemes.